Abstract：
To provide the first estimates of the risk of suicide after bereavement by the suicide of any first-degree relative and the proportion of suicides in Denmark attributable to suicide bereavement.
We conducted a nationwide nested case-control study defining cases as all Danish-born individuals who died by suicide in Denmark between 01 January 1980 and 31 December 2016 (n = 32,248), age-matched to four living controls. Using three exposure categories (bereavement by the suicide of a relative [parent, offspring, sibling, and spouse/cohabitee]; non-suicide bereavement; no bereavement) and conditional logistic regression adjusted for pre-specified covariates we estimated the odds of exposure to suicide bereavement in cases versus controls. We tested whether associations differed for men and women, estimated the population attributable fraction (PAF) of suicides in our population at risk that could be attributed to a first-degree relative\'s suicide loss, and estimated the attributable fraction among the exposed (AFe).
Suicide bereavement was associated with an increased odds of suicide when compared with no bereavement (ORadj2 = 2.90, 95% CI: 2.46-3.40) or non-suicide bereavement (ORadj2 = 1.48, 95% CI: 1.25-1.74). There was no evidence to support any interaction with sex. PAF (0.69%; 95% CI: 0.62%-0.77%) and AFe (60.12%; 95% CI: 53.19%-66.03%) estimates suggested that in Denmark 0.69% of suicides, and 60% of suicides among suicide-bereaved relatives, could be prevented if it was possible to address all factors increasing suicide risk in suicide-bereaved relatives.
Suicide bereavement in relatives and partners contributes to at least one in 145 suicides in Denmark.
We conducted a nationwide nested case-control study defining cases as all Danish-born individuals who died by suicide in Denmark between 01 January 1980 and 31 December 2016 (n = 32,248), age-matched to four living controls. Using three exposure categories (bereavement by the suicide of a relative [parent, offspring, sibling, and spouse/cohabitee]; non-suicide bereavement; no bereavement) and conditional logistic regression adjusted for pre-specified covariates we estimated the odds of exposure to suicide bereavement in cases versus controls. We tested whether associations differed for men and women, estimated the population attributable fraction (PAF) of suicides in our population at risk that could be attributed to a first-degree relative\'s suicide loss, and estimated the attributable fraction among the exposed (AFe).
Suicide bereavement was associated with an increased odds of suicide when compared with no bereavement (ORadj2 = 2.90, 95% CI: 2.46-3.40) or non-suicide bereavement (ORadj2 = 1.48, 95% CI: 1.25-1.74). There was no evidence to support any interaction with sex. PAF (0.69%; 95% CI: 0.62%-0.77%) and AFe (60.12%; 95% CI: 53.19%-66.03%) estimates suggested that in Denmark 0.69% of suicides, and 60% of suicides among suicide-bereaved relatives, could be prevented if it was possible to address all factors increasing suicide risk in suicide-bereaved relatives.
Suicide bereavement in relatives and partners contributes to at least one in 145 suicides in Denmark.
摘要：
目的：提供有关任何一级亲属自杀的丧亲后自杀风险的初步估计以及丹麦自杀丧亲的自杀比例。
方法：我们进行了一项全国性的巢式病例对照研究，将病例定义为1980年1月1日至2016年12月31日在丹麦因自杀死亡的所有丹麦出生个体（n=32,248）。年龄匹配四个生活控制。使用三种暴露类别(亲属自杀导致的丧亲[父母，后代,兄弟姐妹,和配偶/同居者]；非自杀丧亲；无丧亲）和针对预先指定的协变量进行调整的条件逻辑回归，我们估计了病例与对照组中自杀丧亲暴露的几率。我们测试了男性和女性的关联是否不同，估计了我们人群中自杀风险的人口归因分数（PAF），这可能归因于一级亲属的自杀损失，并估计了暴露者中的可归因分数(AFe)。
结果：与无丧亲（ORadj2=2.90，95％CI：2.46-3.40）或非自杀丧亲（ORadj2=1.48，95％CI：1.25-1.74）相比，自杀丧亲与自杀几率增加相关。没有证据支持与性别的任何互动。PAF（0.69％；95％CI：0.62％-0.77％）和AFe（60.12％；95％CI：53.19％-66.03％）估计表明，在丹麦，自杀率为0.69％，自杀亲属中有60%的自杀，如果可以解决所有增加自杀丧亲亲属自杀风险的因素，则可以预防。
结论：在丹麦，亲属和伴侣中的自杀丧亲行为至少导致145例自杀中的1例。
方法：我们进行了一项全国性的巢式病例对照研究，将病例定义为1980年1月1日至2016年12月31日在丹麦因自杀死亡的所有丹麦出生个体（n=32,248）。年龄匹配四个生活控制。使用三种暴露类别(亲属自杀导致的丧亲[父母，后代,兄弟姐妹,和配偶/同居者]；非自杀丧亲；无丧亲）和针对预先指定的协变量进行调整的条件逻辑回归，我们估计了病例与对照组中自杀丧亲暴露的几率。我们测试了男性和女性的关联是否不同，估计了我们人群中自杀风险的人口归因分数（PAF），这可能归因于一级亲属的自杀损失，并估计了暴露者中的可归因分数(AFe)。
结果：与无丧亲（ORadj2=2.90，95％CI：2.46-3.40）或非自杀丧亲（ORadj2=1.48，95％CI：1.25-1.74）相比，自杀丧亲与自杀几率增加相关。没有证据支持与性别的任何互动。PAF（0.69％；95％CI：0.62％-0.77％）和AFe（60.12％；95％CI：53.19％-66.03％）估计表明，在丹麦，自杀率为0.69％，自杀亲属中有60%的自杀，如果可以解决所有增加自杀丧亲亲属自杀风险的因素，则可以预防。
结论：在丹麦，亲属和伴侣中的自杀丧亲行为至少导致145例自杀中的1例。
